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Resources For

Healthcare Carriers

2003-19: 2004 Rate Instructions for Experience-Rated Plans

May 6, 2003

Located at the linked Office of Personnel Management website, you will find two programs for use in developing your 2004 FEHBP proposals. FEHBP Exp Proposal installs the Visual Basic questionnaire and supporting files for new carriers and ExpQ2002 is the most recent questionnaire for existing carriers. There have been modifications to the Visual Basic program since last year, so existing carriers must install and use the recent version for submission. For existing carriers, installing at the original location is recommended, unless the supporting files are moved to the new location. Both of the new installed programs contain the Visual Basic questionnaire, one and two year questionnaires, and Table 3, that combined with your documented cost of benefit changes, will constitute your rate proposal for participation in the FEHBP for 2004. You must fully document all estimates with respect to assumptions and actuarial methodology. Your submission is due by June 2, 2003.

The following table illustrates what you must submit.

Description

New Experience Rated Plans1st-Year participation in 2004

Plan's in 2nd -Year of participation in 2004

All Others(3 or more years participation in 2004)

VISUAL BASIC Questionnaire

X

One Year Questionnaire Real Text File(RTF)

X

Two Years Questionnaire (RTF)

X

Documented Cost of Benefit Changes

X

X

Summary Statement of 12/31/2002 Accounting Statement

X

Table 3 (RTF)

X

X

Plans for which 2004 is the third year, the fourth year, or the fifth year or more of participation should use the VISUAL BASIC Questionnaire. Plans should select the appropriate year of participation under tools/options.

HMO's must complete Table 3 and include it with the submission and resubmit Table 3 with additional May data as soon as it is available but no later than June 20. If you provide some services through capitation, enclose separate schedules covering 2002 as well as the four and five month periods for 2003 in which claims are broken out by capitated services, non-capitated services, and total services./

Fee-for-Service plans may omit Table 3 but must confirm that the monthly submissions are current and consist of all claims, for instance, all prescription drugs and mental health costs must be included.

The one year questionnaire, two year questionnaire, and Table 3 are accessed under help.

If your plan has two options, rate each option as a separate plan and submit separate documentation for each option.

You should set your proposed rates so that the sum of the ending special reserve balance plus the ending contingency reserve balance moves toward the reserve goal of two months of total outgo. If you project that your rates will not achieve the reserve goal as of December 31, 2004, please explain why your proposed rates are more reasonable than rates which would achieve the two month goal.

Include in your submission: your proposal; the summary statement to your December 31, 2002, accounting statement; documented cost of benefit changes; the questionnaire; and appropriate tables. Send one copy to ACTUARY@OPM.GOV.

Send the VISUAL BASIC portion of your submission by enclosing the data file and report file created by the program. You may send the RTF portion of your submission in a WORD or EXCEL format.

If you are submitting a one year or two year questionnaire please send a duplicate copy to your OPM contract office. If you are submitting a Visual Basic questionnaire please send a duplicate copy of only Table 1 and Table 2 from the questionnaire to the OPM contract office. The email address for all Plans except the BCBS Service Benefit Plan is dagreen@opm.gov.